DC Breast 2024
Learn the details about :
Breast Augmentation
Breast reduction
Breast lift
and more.
Introduction:
This site has been up for about 10 years and is due for an update. So much has changed in the world of breast augmentation.There are more styles of implants than ever. Some styles have come and gone and some are out of favor. Some manufacturers have come and gone.
Lifts versus reductions , the need for implants or not, still continues to confuse patients.
This site is dedicated to answering the most common questions and concerns patients approach me with. I hope it is of value to you as well. Each topic, Augmentation, Lift and Reduction has its own section. I have added an additional section about other procedures patients commonly combine with cosmetic breast surgery. All sections are personally writen by me and I try to express how I approch my surgeries what I think works and what does not.
Additional surgeries are detailed in my main website WWW.ATCosmetics.com
I hope this website helps you calrify and dispel the myths of the internet, It has been honed in from over 20 years of experience and common sense.
Augmentation faq:
Do I need implants ?
how do I choose an implant ?
How do you help your patients find the right implant ?
Above or below the muscle. ?
Where is the scar ?
What is recovery like?
Who makes Implants in the USA ?
What kinds of implants are there ?
Do I need a lift too ?
do Implants need maintainence ?
When do Implants need to be changed out?
Can implants be combined with a lift. ?
When will I see my final results ?
Can Implants just be removed ?
Whats a capsulectomy?
What is BIA-ALCL
What is Breast implant illness?
Summary if this page is TLDR…
Do I need implants?
Oddly enough this is one of the most common questions I am asked at an initial consultation and the most honest answer fo course is “no one needs them”
What I help my patients figure out is if it is their goals are reasonable, if they are healthy enough, and if they consider implants will it achieve their goals. Adding implants to a patient who is already a DD will only lead to issues later in life, adding implants to a small A cup patient will often make them feel normal… I shoot for normal.
How do I choose an implant?
The Best advice I can give my patients is don’t choose you implants based on photos on the web. In most instances you cant tell how tall or broad the people in headless photos are. Two patients may look the same but have very differrent size implants to accomplish the same look.
In my offices we have actual implants to try on, on your own frame in front of a full length mirror. I think this is far more valuable and realistic than computer generated images.
Bring a shirt , bring a blouse, bring a friend to your sizing session. Bring your wish pics, but don’t show them to me until after sizing. I dont want to be biased until we find what we like, at that point the photos help me to see if we are on the right path to acheiving your goals.
How do you help your patient choose an implant?
If you have seen my photos you might have noted that I always include the full torsoe of the patients. A pictue box of just the breast would tell you nothing about the sense of balance I try to achieve. To me, augmentation is about the height, shoulders and hips of the patient. If an implant is too small and does not fill the width of the breast it will look like a torpedoe. If an implant is too wide it will make a patient look heavy. In a sizing session I first start by changing the withof the sample implants. I like to see the diameter fill the with of the breast and have enough curve to balance with the shoulders and the curvature of the hip. A patient with slender hips might have a narrower implant, a patient with wider hips wil balance better with a wider implant.
Once we like the width togethe we can the change the size of the implant by going to a low, moderate or high and even ultra high profile at that with.
Augmentatio is not just about the breast it about the size of the individual patient.
Above or below the muscle:
Implants can be placed above the chest wall Muscle, the “PEC” or pectoralis, or below.
I am a big fan of below the muscle. When implants are below this muscle they tend to look more natural, the risk if infection is lower, future mammograms are better and the risk of the implant becoming firm and tight known as ‘CC” or capsular contracture is lower. Under the muscle you are essentially massaging the implants whenever you move your arms. This helps to keep them soft. There is also another reason to go under the muscle that is future thinking. Many patient will return years later needing a breast lift. Natural breast tissue, even with an implant underneath wil relax and droop over time. Often childbearing, weight gain and or loss are a contributing factor. When a patient who has had an implant needs a lift, that lift is safer if the implant was placed under the muscle because the breast tissue is still attached to the muscle beneath it–
To me there is only one negative – when patients have implants below the myscle, if they vigoursly flex their pecs, the pec will contract and pull on the implant leading to distortion. Medically this is called muscle flexion deformity. I really dont think of it as a deformity, but more a s a fact or consequence of submuscular placement. If the patient is a body builder it is certainly somthing to consider, but for the majority of my patients who don go around flexing it is of little consequence.
Who Makes implants?
To produce and bring an implant to market is a huge undertaking. Manufacturers must go through a lengthy and expensive approval process. Many implants that are used around the world are currently not allowed in the U.S. I don’t know if that will change. Until recently we had 4 Manufacturer options now we have 2 .
Mentor– Mentor has been making implants for decades and have an excellent track record for customer satisfaction and reliability. I have used these implants since 1996. These implants have a very stretchy shell which I belive translates into durability and longevity. Because of this they tend to be easier to insert with an implany funnel. They are now a subsidiary of Johnson and Johnson bought out a number of years ago. Their implants are made in the USA which I like as well.
Allergan- Allergan purchased Inamed ,formerly Mcghan , a long time implant maker,also currently producing in the US. They also make an excellent product. I find the shells somewhat thicker and for that reason I tend to favor menntor, but I have used both exthesively.
Sientra- Sientra was an off shoot of Mentor, trying to bring more competition to the market. While currently made in the US, the initially had production problens at their costa rican plant and recently declared Bankruptcy. While just recently purchased by another company I don’t know what their future will be. I never used Sientra because they were silicone only. Many of my patients still request Saline
Ideal- The Ideal implant is gone. They went out of business in may of 2023. They produced a ” Structured saline ” implant that was supposed to feel more like silicone with the advantage that leaks would be easy to detect. I used this implant a few times and found it cumbersome and likely prone to failures. That was the case and they shut down.
What kind of Implants are there?
This is a big and often confusing question. I will do my best to clarify.
Silicone/Saline
The two main catagories are Silicone or Saline. While they all have a similar outer shell Silicone implants are filled with a silicone gel at the factory, Saline implants are filled with salt water at the time of surgery. The volume of a saline implant can be adjusted , Currently the volume of a silicone gel implant can not. Silicone tends to be softer, mushier, more natural looking and feeling. Silicone has less rippling around the edges that sometimes a slender patient may feel. Silicone implants can not have thair size adjusted and there is recommend screening at intervals to make certain the implant is intact.
Smooth Surface/Textured
A Silicone or Saline implant can have a smooth surface or a rough textured surface. There is some evidence that the rough surface may lead to a lower likelihood of the scar tissue contracting (capsular contracture “CC”) around the implant. Contracted implants will feel firm and unnatural. I am not a fan of textured implants. They tend to stick to the tissues in the body and in my opinion look less natural. I do not belive they make a big difference in contracture rates when implants are under the muscle. Lastly, They have been linked to an extraordinarily rare lymphoma known as Breast Implant Associated Anaplastic Large Cell Lymphoma. While Extraordinarily rare and effectively treated I just don’t think the risk is worth it. I favor smooth implants.
Round Or Shaped (Teardrop)?
Implants can be round or they can be shaped like a teardrop- teardrop meaning smaller at the top and larger at the bottom. I have never like tear drops for 3 reasons.
1) These implants must be textured so they stay put, as noted earlier I find this stuck on look less natural .
2) If the teardrop rotates the breast may look odd. If a round implant rotates no one will ever know or care.
3) Silicone implants under the muscle will take on a teardrop shape. If these rotate no one will ever care.
Soft, Medium or firm ?
Saline is always saline and a firmer feeling implant, but gel implants can now be soft, medium or firm. All of todays gel implants are “cohesive” meaning that the gel sticks together if the implant shell ruptures, but some are more cohesive than others. The more cohesive the more firm.
I favor the soft implants for two reasons:
1) I feel these look and feel more natural
2) Soft implants can be placed through smaller incisions leaving smaller scars.
Low profile, Moderate profie or High profile ?
All implants now have different projections, thet means they can stick out from the chest to different degrees.
Allergan uses the lingo Low, Moderate and High– Mentor calls the same thing Moderate Calssic, Moderate plus and High. Mentor even has an ultra high.
In general the most popular implant in my practice is the moderate plus. I call it the ” Did she ? or Didn’t she ? ” implant. I wory that the low profile may not do enough for all but the most petite of patients. I feel that the moderat plus can be shown off when wanted and hidden just as easliy. Hi profies ar pretty much the ” hey look what I did ” implant. They can look very provocative, but you can’t hide’m –The ultra high even morsoe.
So, we have Silicone or saline, Smooth or textured, round or teardropped and now low, moderate and high profile. It can be daunting and that is where I try to help my patients through the huge number of options.
Where is the scar?
Breast implants can be inserted in a few different ways:
Infra mammary : This means at the bottom of the breast usuallin or just above the fold. It is the most popular approach and offers good visualization.
Periareolar : This means a scar around the bottom of the areola where the pigmented areola and the less pigmented skin meet. While I still use this approach on occasion there has been recent evidence that capsular contracture rates may be higher. Transit through the areloa involves cutting some of the breast milk ducts. The concern is that these duct may carry bacteria leading to capsular. For that reason I favor under the breast which usually will avoid the ducts.
Armpit : I have never favored this approach. I personally feel it is less predictable. I am aslo concerned about implant contamination from galnds in the armpit.
Through the belly button : Called Trans umbilial breast Augmentation” – This is a largely blind insertion of only saline implants. This one is not for me.
Through a tummy tuck: This is called “TABA or Trans Abdominoplasy Breast Augmentation” and of course you must be having a tummy tuck at the same time. This too I will use on occasion with saline implants, but it too is a partially blind dissection of the implant pocket so there can be a higher risk of bleeding or assymetries.
What is the recovery like?
Breast augmentation is done under a light general anesthesia. I tell my patients that when they awake they may feel like a baby elephant is sitting on their chest. In surgery I inject local anesthesia into the muscles, the incision and around the implant to make recovery easier. While each patient is different most are off pain medication in about 48 hours. Most will take a week out of the offfice, but many will be able to work from home much sooner. I ask my patients to refrain from excersize for 21 days after surgery, We don’t want to elevate the blood pressure. Risk of bleeding diminishes by the end of the third week.
Will I have cleavage ?
This common question really depends upon your starting situation. When implants are placed under the muscle the must stop wherre the pectoral muscle inserts into the sternum. Going beyond that cam lead to “Synmastia” which basically means “One big breast”. I always go as close to the midline as the pec muscle will allow, but I can not change the sternal space. A patient with a narrow sternum will achieve more cleavage, a patient with a wide sternal space will have less. Regardless, clevage still requires a bra. Implants are pushed outwards by muscular forces. When a patient lays down the implants will move towards the arms, when they stand the implants will comback to the middle ….Just as a natural breast would do.
Above the muscle requires is not affected by the pec muscle insertion, but if too close has a higher risk of synmastia. As you know by now I am a big fan of submuscular.
Can Implants be combined with Lifts ?
Yes, Implants can be combined with crescent lift, Periareolar lifts ( Benelli), Lollipop fifts and full lifts. These are discussed in the FAQ on the ( LINK) lfit page and in the next question.
Do I need a lift with my breast implants ?
This will be discussed more in the breast lift section, but to summarize here:
If you have just a little droop or no droop at all you wiil generally just need a routine augmentation.
If you have a lot of droop or sagging you will likely need a lift or the natural breast will hang below the implant.
Patients in the middle with a moderate degree of droop may or may not need a lift depending on the size and profile of the implant they have selected. Many of these patients will allow me to perform a lift if I feel thaye may need one once I have inserted the implant in the operating room.
When will I see my final results?
When implants are placed under the muscle , the muscle initially pushes on the implant pushing them upward. I call this “too big, too tight too high, too swolen.”
Over the next 3-6 months the muscle will relax and fullness up top diminishes as projection of the implant increases. Parients must be involved in this dropping process through massage and stretching exercises. If the implants do not drop evenly that could mean a trip back to the operating room. Paradoxically when the implant are at first too high patients are concerned that the might have gone to big. When the implants drop to their final location the same patient might feel too small. Bigger is not always better, as discussed above i strive for a sense of balance.
When do Implants need to be changed out ?
We start to see a rise in the rate of saline leakage after about 10 years, but that does not mean the implant could not go longer. After 10 years a patient could take a wait and see approach if they wish or choose to go ahead and proactively exchange the implants. I prefer it if may patients see me at least once a year for evaluation. If I have seen that patient recently and I know there are no issues the I am prepared for a routine exchange. If I have not seen the patient in years I have no way of knowing their status with the implant is deflated. This can affect how I plan the surgery.
We used to say that silicone implants should be electively changed at 10 Years, and then we weren’t sure. All new implants on the market are more cohesive than their older versions so we expected them to last longer and behave better. Over the past few year I have begun to recommend 10 years once again ( So has Allergan). I have had a number of patients who are well, look good, but unkowingly have ruptures discovered on their screening MRI’s between 10 and 12 years. It is much easier to exchange a silicone implant before it leaks than after so 10 years still makles sense to me. A ruptured implant can increase the risk of capsuar contracture. Please don’t ignore routine folllowup and screening with silicone.
Do Implants require Maintainece?
Implants are a medical device and eventually they will fail. If you have ever destroyed a credit card by bending it back and forth until it cracks, you have created what is called a fold flaw. This is how the shell of a slaine implant may give way over time. If youve ever heard the phrase “like dissioves like” in chemistry this is how a silicone implant gives way. The molecules of silicone inside the implant slowly dissolve the shell over time.
If a saline implant leaks you will generally know it quickly because you body will absorb the salt water and deflaton is easily noticed. Slicone leaks are harder to detect because the silicone stays in the implant pocket an the patient may look perfectly normal. The FDA recommends an MRI 5 yaers after surgery and every two to three years thereafter to check for leaks.
Can implants just be removed?
Implants do not have to be forever. Lives change, weight changes, age changes and for some there comes a time when they just don’t want to be bothered by future maintainence or exchanges. Saline implants can oftem be removed under local anesthesia. I prefer to remove silicone implants in the operating room in case they are leaking an a thorough cleaning of the pocket is needed.
With the volume of the implant removed the breast will deflate leading to laxity. By the time an implant is removed the skin has been stretched over it for may years and it will not go back to where it was. Many patients will choose to do a breast lift at the same time as implant removal.
Sometimes patients are unsure if they want a lift or even a lift with a smaller implant. For patients with Saline implants we can deflate the implants without a surgery. The patient then has the opportunity learn once again the size of their natural breasts, decide if they want a lift and even size for new implants. The old implant shlls will eventually need to be removed.
Unfortunately silicone implants can not be deflated in the office so a plan is made based on best judgement.
Whats a capsular contracture?
When implants are placed inside the body, as they drop and settle after surgery, the body makes a pocket of scar tissue around the implant. We call this the capsule and the implant will live inside the capsule. Massage and stretching are recommended so that the implants will drop to their desired location, but also so that there is extra room in the capsule so the implant can move around. Motion in the pocket lends itself to a more natural looking result.
In some cases the scar tissue around the implant will tighten–“Capsular Contracture” leading to a firm immobile and sometimes uncomfortable implant. Reported rates of capsular contracture vary widely. I bleive it is far more common in breast reconstruction than in elective cosmetic breast augmentation.
There are many theories about the cause of capsular contractue and every effort is made minimize the risk through meticulous technique and minimal touching of implants during insertion. I favor the use of an implant insertion funnel which minimizes touching or contamination from the skin.
What is an implant Funnel ?
Implant funnels have been developed and marketed for use in silicone gel breast augmentation. Think of the implant funnel as a pastry funnel that shoots out implants as opposed to frosting. Implant funnels allow the already filled silicone gel implants to be easily inserted through smaller incisions. The funnel minimizes implant contact with both the surgeon and the skin to mimimize the risk of infection and capsular contracture. I find them an essential tool in my practice. Because saline implants are inflated only after they are inserted a funnel is not necessary.
Whats a Capsulectomy?
If an implant becomes firm scar tissue around the implant can be released- “capsulotomy” or entirely removed -“Capsulectomy”. Unfortunately even with these measure in some patients contracture can recur. Stratus is a material that can be laid inside the breast pocket after capsulectomy diminish capsular contracture. There is evidence that capsular scar tissue does not grow into it. While it is approved for brest reconstruction by the FDA, use for cosmetic treatment, while not illegal is considered an off label use of Strattice.
What is BIA- ALCL ?
This stands for Breast Implant Associated – Anaplastic Large Cell Lymphoma. It is a very rare tumor that can be found living around the capsule of the implant and most commonly presents as a swollen breast with fluid around the implant. It is almost exclusive to textured implants whic is why I have always favored textured implants. Regardless any patient wit sudden swelling neds to be evaluate and treated if necesssary.
What is Breast implant illness ?
Breast implant illness can be characterized by a variety of symptoms such as fatigue, muscle or joint pai, fog, hair loss weight changes even weakness anxiety or depression. At this time it is not a medical diagnosis because it is difficult to link thes symptons directly to implants. Many other disorders can cause these symptoms as well. If patients have these concerns thier implants can be removed to at least tqake them out of the equation. While some will recommend complete capsulectomy there currently is no medical evidence that it is necessary.
Summary :
Congratulations if you got this far. There is a lot of information above. As a general summory of my approach:
I enjoy sharing all the details with my patient. I hope you gleaned thet here. For most patitnts I favor silicone over saline but continue to offer both. I favor under the muscle vs over. I almost exclusively use smooth implants, I have never cared for textured. I favor an incision under the fold of the breast. I enjoy helping patients to pick the right size that lends itself to balance and proportion. If you are interested in learning more please reach out on my contact form. If you wish to learn about breast lift, lift with implants or reduction plese click these links or adresss the menue bar up top. More information is also available at my main websie WWW.ATCosmetics.com
If there are further question you would like to see here please let me know.
Do I need a Breast lift?
Will a breast lift make me look like I have breast implants?
But I just want a small implant
What kinds of breast lifts are there?
Do you use an internal bra mesh?
What is recovery like?
Will I look great from the start?
Will the scars be visible ?
TLDR summary
Do I need a breast lift?
Probably one of the most common questions I encounter. Here is what I tell my patients:
“I you like the way you feel in your bra, you don’t want to be bigger and you don’t wwant to be smaller, but when that bra comes off your breasts head south then you may be a good candidate for a breast lift.”
” if you wished to be bigger in that bra you might consider a lift with the addition of a breast implants.”
” If you wished to be smaller in that bra the you might consider a lift with breast reduction”
The only time I will try to direct someone differrently is if they are trying to have me lift very heavy breasts (and that is not uncommon!) Gravity wins. Heavy breasts go south again more quickly than you might imagine. For the heavy breasted patient I might recommend lift with reduction.
Willl a breast lift make me look like I have breast implants?
This is a common misconception. A lifted breast of any size will take on a teardop shape with most of the breast toward the bottom and likely some degree of droop. Ultimately this is what natural breasts do and even a lifted breast is a natural breast. Implants provide increased volume but mainly fullness at the top of the breast. I think in the media in the country (perhaps because of people like me) we are more used to seeing implanted breasts than natural breasts. It is important that patients understand the differenc or thy run the risk of disappointment with lift alone.
But I just want a small implant …
Again, I hear that a lot. Understanding that an implant enhances the top of the breast many patient who “like the size of their breast in that bra already” will ask for just a small implant.
We spoke in the breast augmention section about finding the right width implant that fills the diameter of the breast. This also determins the height of the implant. For most patients if I pull out a small implant to add to their lift it will have a small diameter. If I place that implant in surgery it must sit at the fold of the breast and will not be tall enough to achieve upper pole fulness.
As I recommend the correct diameter…… then the volume starts to go up in this patient that did not want to be larger……..
What kinds of lifts are there?
Crescent lift: This is the smallest lift. It involved taking a pinch of skin from above each areola and pulling the nipple and areola upwards. It will make the areola slightly more oval in shape. I might turn to this lift if a patient has a small difference in theit nipple position
Periareolar : Also called a Benelli lift, and purse string lift this takes away a donut of skin around the areola. Patients must be warned because there is a lot of puckered skin around the areola that takes a few months to flatten and relax. I use this lift sparingly because the tension in this lift can lead to Areolar stretching or scar widening. This lift is sometimes used just to make the areola smaller. Even though we call it a lift, I think of it more as a moderate thghtener.
Circumvertical: When this lift is closed the scar looks like a lollipop going around the areola and then vertically down the front of the breast. Often called a lollipop lift. I do not care for this lift. It tightens breast tissue fom side to side, but most laxity is top to bottom, I just dont feel that it does enough. Pulling out a diamond of skin from side to side elongates the height of the incision (think of closing a diamontd into a straight line). The nipple has to be placed at the top of the scar and often when I see thes posted the nipples are just too high. To correct this a wedge of skin is taken from underneth which turns it into a full lift which likely should have been done in the first place.
Windoshade lift: (Name ) not really a mainstream lift. This pushes the breast upwards with verticle tightening only, Like a window shade pulled down over your breast. Without a vertical frontal scar there is no horizontal tightening and I find this leaves the breasts squarish looking. A full lift (see Below) adresses this problem.
Full lift: also called an anchor or kehole lift , but actually named after Dr.Wise in the 50’s– a “wise pattern lift”. I call this the “big bad lift” because it leaves the most scars, but because of those incisions it allows us to removes the most sking and give the greatest tightening. With a scar around the areola, down the front of the breast and underneath the fold as well. It give both a vertical and horizontal tightening of the breast. It is the mainsay of most breast lift (and reduction) surgery.
Scarless breast lift– Beware the internet….. a few years ago people used this term to promote augmentation. Implants do fill loose skin, but that is not a true lift. Today I am seeing practices advertise radio frequency skin tightening with a probe that burns the tissue under the breast. No pre or post exames show at least on that site. This one scares me so far.
Do you use an internal bra? An internal bra involves using an internal mesh ( that will eventually disolve) to add additional support to a lift. The Idea is that an extra layer of scar tissue is left behind lending further suppot to the breast. If a patient want it I can certainly provide it, but to me it is one more thin that could move or become infected. I believe the longevity of lifts are determind by the patients slkin quality (some are more lax than others and will relax sooner) and the weight of the breast that is left behind. To reiterate garvity wins and heavy breasts go south more quicky mesh or not.
What is recovery like,
The most common complaint for a patient having a lift alone is a burning sensation of the incisions. It is a skin tighteng operation an skin tends to hurt less than operations i perform such as augmentation ot tummy tuck where muscles are streched or pulled. While performed under a general anesthesia I leave local anesthesia in the tissues and the incicions at the end of surgery to decrease post operative pain. Most patients will take about a week of and if allowed can work from home. Once again I advise no strenous activity for 21 days.
Will I look great from the start?
Short answer no. We as plastic surgeons make the breast slightly too tight because we kow the breast skin will relax over the next three to six months. Initially patients will look tight and flat on the bottom and somewhat bulgy on the sides. We call this “boxy”. Over those post operative months the breast will round , settle and take on its final shape. If we like the shape, we are done, if not we talk about adjustments if necessary. While touch ups are rare it is important to understand that what you see on day one is not what you will see sixx months later.
Will the scars be visible?
All scars are visible, the only question is how much they will draw the eye. As a palstic surgeon I am in the business of scars and always working to minimize their impact, but the patients genetics (Mom and Dad) may ultimately determine the degree of prominence and visibility. Lighter skin patients tend to make better scars than darker skin patients genetically. I ask my patients ” if you were to make a bad scar would the surgery be worth it to you ?” While most patients make good scars this, in my mind, is the safest way to approach the surgery.
TLDR Sumary: In this “blogsite” i dont focus on evey possible complication( which is done in the in person consult), but mainly on the question my patients come in asking. If you ahe read the above we have discussed who need a lift, the kinds of lifts, the expectstions and post operative course. If you have a question you would like to see here please e-mail me. The next section “breast lft with implants” combines the aumentation section and the lift section…… read on if you like.
So I am not going to rehash the first two sections here as the FAQ are very similar and the recovery is a blending of breast augmentation and breast lift recovery.
Breast augmentaion with small lifts behave mainly like an augmentation alone. Breast augmentation with a full breast lift (fulll Mastopexy ) is a very different animal and worthy of discussion:
Folow me here:
Breast implants under the muscle start out high, but as the muscles relax they drop to their final resting position. Usually predictably.
Breast lift goal is to go from a low position and stay at a higher position. Again usually predictably.
These two operations at he same time fight one another:
We want the implants to drop evenly, while, at the same time the lift is encouraging them to stay up. We want the lift to stay tight while at the same time the implants are trying to stretch it down.
This fighting can lead to either:
Implants dropping unevely
or
More laxity than desired as the skin relaxes.
Surgical Planning:
Because of this the combination of Impant and full lift at the same time has a higher touch up and adjustment rate in the United States than many other things we do.
Now I am not trying to scare you off. This is one of the most populat surgeries that I perform, but I do try to guide my patients down the best path
Patients with smaller or lighter sagging breasts tentd to do better in the combo. There is less soft tissue swelling leadin to less reurrent laxity an effect on the implants.
Patients with large, dense and heavy breasts tend to do worse. The post operative swelling in an already heavy breast want to bring it south. For that heavy breasted patient I might recommend a lift alone or even a reduction (heavy breasts go south) first and place the implants later once the lift has healed. Interestingly I woud say about 90% of these patients end up being happy with the lift or reduction alone.
Patients in the middle, not with light breasts, but not with overly heavy breasts are more challenging. They must be well informed about the combination and be willing to accept the variability. You can not do an agressive reduction while doing an augmentation– it is too much stress on the blood supply to the tissues, but often will perform some limited natural volume reduction. This effectively tips the moderatly sized natural breast towars the smaller natural breast at the same time removing some of the tissue that will want to go south over time.
This is complex, rarely discussed on other sites, but I hope it makes intellectual sense to you. as always please reach oout wit you questions and comments.
What is a breast Reduction?
What kind of breast reductions are there?
Will it solve my back pain ?
How do you Pick a size?
Will I look like I got implants?
Will my insurance cover this?
What is the recovery like?
It is paradoxical that in my practice some of the happiest patients are those whose breasts I make bigger, but also those whose breasts I make smaller. Breast reduction can be life altering and I commony hear ” I wish I had done this years ago”. A lift is by definition part of breast reduction surgery, but ast discussed in the lift section (link) lifted and reduced breasts behave and look like natural breasts.
What is a breast reduction?
Whether you realized it or we have mainly dscussed breast reduction in the breast lift section. A breast reduction is basically a lift but the remaining breast is made smaller before it is pushed upwards. While there can be different scar patterns The most common is the still the “Wise” pattern aslo called keyhole or anchor. Just like a full lift this pattern offers both a vertical and a horizontal tightening of the skin. Recovery is very similar to a lift.
What kinds of breast reduction are there?
A standard breast reduction attempts to perserve blood supply to the nipple and areolar area. For some this will allow them to breastfeed and maintain nipple sensation, but it is not guaranteed.
A free nipple graft breast reduction is sometimes used for breasts that are so large or so droopy that blood supply to the nipple can not be maintained. In these patients the nipple and areola are remoed completely at the start of reduction and then replaced at the end as skin grarfts. These patients will loose sensation, and not be able to breastfeed. Often some projection of the nipple is lost. Pigment can be lost as well, which vould be more noticible in a darker pigmented patient, but color can be restored later with tatooing.
Will it solve my back pain?
There have been many studies that show breast reduction improves back,neck shoulder pain and other symptoms of carrying excessively lare breasts. While that has been my experience, I never promise resolution of the symptoms to my patients. While I strongly believe that decreasing the weight of a heavy breast is a step in the right direction there can be other causes of these symptoms where reduction man not help.
How do you pick a size?
This is perhaps the most difficult question. Breast reduction is both science and art. While always wanting to accomplish my patients goals there are limits to how much tissue can be removed while still keeping the nipple and areola alive. A cup ,Bcup, C/D cup and so on mean very different things to different people. Victorias secret is notorious for telling clients that there cup size is much larger than it really is. I strive for a sense of proportion that is determined not only by the patients goals but also their height, hips and shoulders. Very much like breast augmentation planning but in reverse.
Because I get a lift with a reduction will I look like I got implants?
Just like a lift alone, the reduced and lifted breast will take time to drop, settle and declare its shape. When it does it will take on a tear drop shape and some laxity like an unoperated breast. For patients wanting more fullness up top an implant could be added after the reduction haas healed, but rarely to ptients do this.
Will my insurance cover this ?
Sadly, in most cases no. For many it is excluded directly in their healthcare policy. Even if not, often paatients have to jump through hoops to get it done. In some cases insurance will not cover it unless a very large amount of tissue is removed, more than a patient might wants. For appropriate candidates we will try to help them navigate the insurance system but it is becoming more and more rare to see approvals. We offer a discounted electivecosmetic rate for elective breast reduction when insurance is not an option.
How long is recovery?
While each patient is different the average patient will recuperate for a week to 10 days. Most are off pain medication in 48 hours. I ask my patients to avoid any activities for 21 days after surgery.
Fees
If you click on the link below it will take you to the fees section of may main website WWW.Atcosmetics.com. I hate to admit it but post covid pricing has increased dramatically. Many qualified pesonnel left healthcare, many left hospitals, some retired and as a result hospitals are paying more to get people back. If our practice were not competitive we could not offer you the quality staff we have today. Inflation and high interest are also reflected in the drugs and equiptment we must purchase and maintain. Peraonally I think drug manufactures are gouging– many inexpensive drugs have become bizarrly exepensive.
As always I try to be candid and competitive in my pricing. Please know that our standard fees are inclusive of the anesthesia and facility. I don’t like surprises and I try not to give them to my patients. Pre operative labarotory tests, clearances and post operative medications are not included but are covered within most patients health plans. If breast tissue is removed by law it must be sent to a pathologist to make sure no breast cancers are found. While on some occations the pathology fee may be covered by insurance, if it is not you will receive a bill forn the pathologist. It is the one fee i have no control over.
Some patients request Xparel. Xparel is a long acting local anesthetic that I mainly recommend for Tummy tucks. Because it is under patent, hence expensive, we offer it as an option for patients who want it. Xparel adds $500.
In certain special cases I may have to alter pricing but I always try to adhere to what is posted on the site. When patients are able to safely combine surgeries savings on sergical fees can be offered.
LINK to ATCOSMETICS / FEES
Common surgeries perfomed with breast surgery:
There is such a thing as “too umch surgery in one day “, but with in the bounds of safety, it is common to add additional procedures. Breast surgeries Iwhen combined with a tummy tuck are often referred toa s a mommy makeover. Below is a list of some of the commly addded procedures, and more can be fout at my main site www.atcosmetics.com
Shaun add procedure page to here from old site and then I will edit it.
About Dr. Adam Tattelbaum
The son of a jeweler and a clergyman Dr. Adam Tattelbaum grew up in a household where artistry and enhancing the lives of others took equal place. “I always knew that I wanted an occupation where I could work with my hands but also make a positive difference in people’s lives. I can think of no field in medicine that is more creative, gratifying or exciting.”
Born in New York City, Dr. Tattelbaum has performed plastic surgery in the Metropolitan Washington D.C. are for almost 30 years. Trained at Columbia, Harvard and Georgetown University, Dr. Tattelbaum is certified by both the American Board of Plastic Surgery and the American Board of Surgery. He is a member of the American Society of Plastic Surgeons as well as the American Society of Aesthetic Plastic Surgery which serves as a mark of distinction in cosmetic plastic surgery. He serves on the clinical faculty at Georgetown University, where he has taught. Listed on multiple occasions as one of Washingtonians Top Doctors and Bethesda Magazine. His greatest joy is the teaching and education of his patients. He offers a common sense approach to cosmetic surgery and offers the same advice to patients that he would offer to his family or friends
Husband and proud father of two, Dr.Tattelbaum and his wife live in Maryland.
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